內視鏡隆乳簡介
2011/11/17 16:51 | by 所謂內視鏡隆乳手術就是運用內視鏡儀器進行隆乳手術.1990年代台灣開始使用內視鏡來作上額頭拉皮手術, 內視鏡隆乳效果良好,副作用少,刀疤小,流血少, 內視鏡隆乳手術後傷口較不痛,恢復快等優點, 內視鏡隆乳手術逐漸取代傳統美容手術如拉皮,隆乳及腹部整形手術.
內視鏡隆乳手術在完全透過內視鏡觀看下做完所有的手術，內視鏡隆乳是在內視鏡輔助下，結合電燒及剝離器以切割剝離所要置入的義乳空間。內視鏡手術時間較長，而其最大的好處是止血及組織剝離切割徹底。
內視鏡隆乳優點
內視鏡隆乳出血量極少，疼痛感減低，復原快速等眾多的優勢，比起傳統隆乳的手術出血量彽,疼痛度的機會也降低。
純熟的內視鏡隆乳技術- 做內視鏡隆乳時，內視鏡隆乳專家醫師可藉內視鏡之助，讓手術過程一目了然，不致傷到較大的血管或神經，且在剝離胸大肌下緣時是用電刀而不用暴力，可幾乎不流血，也能做出既自然又漂亮的乳溝，但技術要夠純熟才做得到，這是需要較長時間磨練的，所以不是只要用內視鏡的手術結果就一定會很好，最重要的還是那位使用內視鏡的內視鏡隆乳專家醫師有沒有足夠的經驗。在內視鏡的輔助下剝離完胸大肌後，第一次沖洗傷口的情形，水中僅有極淡的血跡，失血量不到1cc
術前幾乎完全平胸，植入300cc內視鏡隆乳後，仍能輕鬆擠出乳溝，穿無肩帶內衣時，上身前傾即可出現迷人的乳溝線條，使用改良型的手術器械，筆者過去是用10mm的內視鏡鏡頭，這種鏡頭的視野雖大，卻僅能將影像放大三到五倍，在剝離胸大肌時仍然容易傷到較細小的血管而造成出血；現在則改用4mm的鏡頭，可將影像放大十餘倍，任何細微的血管或神經都看得一清二楚，故能大大地減少失血量並更為降低傷到神經的機率。
傳統隆乳全靠金屬剝離器來完成〝所有〞的剝離工作，必須將剝離器設計得粗壯有力，才能把胸大肌徹底剝離，如此傷口將很難小於三公分，否則剝離器會放不進去；反觀內視鏡隆乳時，剝離器僅居輔助的地位，在筆者的重新設計之下，新型剝離器僅為舊型的四分之一到三分之一大小，加上是用4mm的內視鏡鏡頭，所以只要開很小的傷口﹝約兩公分﹞就能將器械放進去了。
利用模具做正確的定位，根據內視鏡隆乳的直徑做出不同大小的模具，用來做正確的定位和畫線，將可大大地提高內視鏡隆乳手術的精準度。
術前仔細地畫出參考線
參考線是十分重要的，因為內視鏡隆乳在剝離胸大肌時用的是〝電刀〞，而電刀是無堅不摧的，若沒有畫參考線作為剝離範圍的依據，則可能剝離得太過或不及，如此都無法得到令人滿意的結果。
以模具定位出內視鏡隆乳的位置並畫線，標示出正確的剝離的範圍
將胸大肌作精確的剝離
胸大肌內緣僅作部份剝離以避免水袋皺褶太明顯，下緣則作完全剝離，才能讓內視鏡隆乳下降到適當的位置，乳房也能呈現〝自然下垂〞的外觀。
術後半年，乳房已呈現出自然的〝垂度〞儘早做術後的胸部按摩，隆乳後三到五天即開始產生莢膜，若未能在三天內開始做按摩，莢膜一旦形成，便必須花極大的工夫才能將它推開，所以最好能在手術後第三天、甚至第二天就開始按摩，但因為傳統隆乳極為疼痛，且常需插引流管，很少人有辦法在術後一、二天就忍受得了那種疼痛來做按摩；所幸內視鏡隆乳可讓術後的疼痛度大幅減輕，有人甚至只有輕微漲痛感，故絕大多數患者都能在可忍受的範圍內儘早做按摩。
先做往內集中的按摩，一天20次以上
患者務必定期回診追蹤
術後定期追蹤是相當重要的，因為每一位患者的復原速度都不相同，胸形也不一樣，所以術後照護和按摩絕對不是一成不變的，內視鏡隆乳專家醫師會在患者回診時根據實際的狀況作出正確的指示，例如：按摩方式的調整、胸帶和內衣的穿戴方式及藥物﹝內服、注射或外用﹞的使用等等，都對最後的結果影響至巨。
內視鏡隆乳手術後三個月時，左右高低出現落差，故指示患者開始穿戴鋼絲內衣，但須把左側鋼絲抽掉，並將右側肩帶調緊，左側肩帶放鬆，再加強左側下壓的按摩動作
三個月後即可明顯改善
內視鏡隆乳做隆乳時，內視鏡隆乳專家醫師可藉內視鏡之助，讓手術過程一目了然，隆乳不致傷到較大的血管或神經，且在剝離胸大肌下緣時是用電刀而不用暴力，可幾乎不流血。從腋下傷口將內視鏡伸進胸大肌下空間，再透過鏡頭將影像傳輸至影像系統，讓內視鏡隆乳專家醫師一目了然。
內視鏡隆乳的優點如下：
1.乳房形狀和觸感十分自然：
因能精確地剝離出足夠的胸肌下空間，高低位置亦能控制，故植入的內視鏡隆乳不會被侷限或往上移位，也不會高低不一。
術後乳房的形狀幾能亂真，又十分柔較，除非做乳房超音波或電腦斷層掃描，否則不易分辨真假。
2.失血量極少：
早期是以失血量十西西以下為目標，偶爾才能達到一西西以下，現在則已能將百分之八十以上患者的失血量控制在一西西以下，主因為過去是用10mm的內視鏡鏡頭，這種鏡頭的視野雖大，卻僅能將影像放大三到五倍，在剝離胸肌時仍然容易傷到較細小的血管而造成出血；現在則改用4mm的鏡頭，可將影像放大十餘倍，任何細微的血管或神經均能看得一清二楚，故能大大地減少失血量並更為降低傷到神經的機率，所以完全不必放引流管，發生「血腫」的機率仍只有千分之一。可是這種鏡頭的視野很小，如果不是擁有豐富的內視鏡內視鏡隆乳手術經驗，內視鏡隆乳專家醫師手術時可能會分不清楚東西南北。
3.傷害小、疼痛減輕：
術後休息三到四小時即可離院，不必住院。
4.刀口更不明顯：
傳統隆乳全靠金屬剝離器來完成〝所有〞的剝離工作，故必須將剝離器設計得粗壯有力，才能把胸大肌徹底剝離，如此傷口很難小於三公分，否則剝離器會放不進去；反觀內視鏡隆乳時，剝離器僅居輔助的地位，在筆者的重新設計之下，新型剝離器僅為舊型的四分之一到三分之一大小，加上是用4mm的內視鏡鏡頭，所以只要開很小的傷口﹝約兩公分﹞就能將器械放進去了。
5. 包膜攣縮機率降低：
在百分之二以下。
6.病患滿意度極高：
達百分之九十五以上，為傳統手術所不及。
7.應用更廣泛：
在過去，內視鏡隆乳位置太高要修改、內視鏡隆乳破裂須置換、原本放的絨毛面內視鏡隆乳觸感不佳想換成較軟的光滑面內視鏡隆乳甚至發生包膜攣縮須重作時，都不能從原先的腋下刀痕來作，必須改從乳暈下緣開刀，如此不但細菌感染的機率增加，患者也常因害怕在乳暈留下難看的疤痕而裹足不前。目前筆者已利用內視鏡手術技術發展出一套作內視鏡隆乳置換、將內視鏡隆乳位置降低或治療包膜攣縮的方法，仍可從腋下開刀，不會增加新的刀痕，且如果原來的疤痕不好看，還能順便修疤，讓結果更完美。
8.術後一、二天即可洗澡：
傳統隆乳因刀口較大且常需放引流管，故至少一個禮拜都不能洗澡，每令患者感到極為不便；內視鏡隆乳則不然，因刀口小，癒合快速，若術後能用防水膠布將傷口及紗布密封，患者即可在術後兩天左右開始正常洗澡，從來不必擔心傷口發炎或癒合不良的問題。
9.術後兩、三天即可正常上班：
因新式的內視鏡隆乳法完全不必放引流管，疼痛較少且不大會腫，隆乳故絕大多數的患者都能在術後兩天到三天開始上班，上班族大多是利用周休二日前的星期五開刀，在家休息一到兩天後，星期一就能夠正常上班而不感到吃力；家庭主婦也能在術後兩、三天開始做家事，有人甚至在手術當天回家就煮晚餐給家人吃的。
過去我們常聽到有關傳統隆乳的〝讓人痛不欲生〞、〝術後足足在床上躺了一個禮拜都動彈不得〞、〝術後要住院好幾天才能出院〞等令人害怕的情況，如果是做楊內視鏡隆乳專家醫師這種精緻的內視鏡隆乳法，就再也不會發生了。
內視鏡「精緻」隆乳 美到最高點在今日，內視鏡隆乳手術已是我們最常做的美容整形手術之一，根據非正式的統計，台灣每年約有八千至一萬人次接受內視鏡隆乳手術，其中仍以〝經腋下胸肌下隆乳法〞為主流。很不幸的，手術不見得都能成功，若不成功，其主因常在於胸大肌無法作〝精確〞且〝適當〞的剝離，尤其是用傳統盲目剝離的方式，除非內視鏡隆乳專家醫師相當有經驗，否則常發生內視鏡隆乳位置過高、高低落差明顯、乳溝不自然或距離過大等缺陷，近來當紅的〝筋膜下〞隆乳雖能解決部份問題，但它僅適用於乳腺較發達、皮下脂肪較厚的患者，對通常偏瘦的國內愛美女性來說，將內視鏡隆乳置於胸大肌下還是比較好的選擇，因為如果做得好，隆乳觸感和外形都會比較自然。因此，如何能將胸大肌作出精確而適當的剝離，不但是求好心切的整形內視鏡隆乳專家醫師們的當務之急，更是內視鏡隆乳能否成功的關鍵所在。
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